Edit_with_Track_Changes_RFP_-_72049718R00012_TBPS.pdf

U.S. Agency for International Development American Embassy, Jl. Budi Kemuliaan I/1, Jakarta 10110 – Indonesia Tel: (62 21) 3435-9000 http://www.usaid.gov/indonesia bCOVER LETTER

RFP Issuance Date: May 22, 2018

Questions Due Date: June 5, 2018, 14:00PM, Jakarta Time

Closing Time for Past Performance Submission: June 26, 2018, 14:00PM, Jakarta Time

Closing Date for Proposals Submission: July 3, 2018, 14:00PM, Jakarta Time

E-mail Submission to: proposals-indo@usaid.gov

NAICS Code: 541 -- Professional, Scientific, and Technical Services/541990 -- All Other Professional, Scientific, and Technical Services

Authorized Geographic Code: 937

SUBJECT: Request for Proposal No. 72049718R00012 USAID Tuberculosis Private Sector (TBPS) Activity

The United States Agency for International Development (USAID) Mission in Indonesia is seeking proposals from qualified organizations interested in providing the services described in the attached Request for Proposals (RFP). USAID anticipates awarding one Cost-Plus- Fixed-Fee (CPFF) Completion type contract, with a total estimated cost in the range of $17 to $19.5 million, covering a total estimated period of five (5) years.

This procurement will be conducted under full and open competition procedures, pursuant to Part 15 of the Federal Acquisition Regulation (FAR) (48 CFR Chapter I). USAID encourages the participation to the maximum extent possible of small business concerns, small disadvantaged business concerns and women-owned small business concerns in this activity, as the prime Contractor or as Sub-contractor, in accordance with Part 19 of the FAR.

If your organization decides to submit a proposal in response to this solicitation, it must be submitted in accordance with the instructions provided Section L of this RFP. Offerors must also carefully review Section M - Evaluation Factors. Sections B through I of the solicitation will become a substantive part of the anticipated contract with blanks to be completed by the Contracting Officer upon award. Section K - Representations, Certifications and Acknowledgements must be filled out in full.

All questions, comments, requests for clarifications must be sent in writing to proposals-indo@usaid.gov no later than the date and time indicated above.

Contractor Past Performance Information, Technical and Cost Proposals are to be submitted separately to USAID/Indonesia no later than the closing dates stated above. If the proposal is received after the closing date and time, or if it is incomplete, it will not be accepted nor considered unless authorized by the Contracting Officer pursuant to FAR 15.208.

RFP NO. 72049718R00012

USAID TBPS

This RFP in no way obligates USAID to award a contract nor does it commit USAID to pay any costs incurred in the preparation and submission of a proposal. Award of a contract under this RFP is subject to availability of funds and other internal USAID approvals.

Furthermore, USAID reserves the right to reject any and/or all offers if such action is considered to be in the best interest of the Government.

This RFP can be viewed and downloaded from www.fbo.gov . USAID bears no responsibility for data errors resulting from transmission or conversion processes. Further, be aware that amendments to solicitations are occasionally issued and will be posted on the same website from which you downloaded this solicitation. USAID advises interested parties to regularly check the above website for amendments.

Thank you for your interest and we look forward to your participation.

Sincerely, /s/

Albert E. Carrera Contracting Officer USAID/Indonesia

Attachment: RFP No. 72049718R00012

SOLICITATION, OFFER AND AWARD 1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 7900)

RATING PAGE OF PAGES

2. CONTRACT NUMBER 3. SOLICITATION NUMBER 4. TYPE OF SOLICITATION 5. DATE ISSUED 6. REQUISITION/PURCHASE NUMBER

CODE7. ISSUED BY 8. ADDRESS OFFER TO (If other than item 7)

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

SOLICITATION

9. Sealed offers in original and copies for furnishings the supplies or services in the Schedule will be received at the place specified in item 8, or if hand carried, in the depository located in until local time

CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

10. FOR

INFORMATION

CALL:

A. NAME B. TELEPHONE (NO COLLECT CALLS)

AREA CODE NUMBER EXT.

C. E-MAIL ADDRESS

11. TABLE OF CONTENTS

(X) SEC. DESCRIPTION PAGE(S) (X) SEC. PAGE(S)DESCRIPTION

A B C D E F G H

I

J

K

L

M EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND OTHER

STATEMENTS OF OFFERORS

PART IV - REPRESENTATIONS AND INSTRUCTIONS

LIST OF ATTACHMENTS

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

CONTRACT CLAUSESSOLICITATION/CONTRACT FORM

SUPPLIES OR SERVICES AND PRICES/COSTS

DESCRIPTION/SPECS./WORK STATEMENT

PACKAGING AND MARKING

INSPECTION AND ACCEPTANCE

DELIVERIES OR PERFORMANCE

CONTRACT ADMINISTRATION DATA

SPECIAL CONTRACT REQUIREMENTS

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

OFFER (Must be fully completed by offeror)

12. In compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (60 calendar days unless a different period is inserted by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT

(See Section I, Clause No. 52.232-8)

14. ACKNOWLEDGMENT OF AMENDMENTS

(The offeror acknowledges receipt of amendments to the SOLICITATION for offerors and related documents numbered and dated):

10 CALENDAR DAYS (%) 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS(%)

DATEAMENDMENT NO.AMENDMENT NO. DATE

15A. NAME AND

ADDRESS

OF OFFER-

OR

CODE FACILITY 16. NAME AND THE TITLE OF PERSON AUTHORIZED TO SIGN OFFER

(Type or print)

15B. TELEPHONE NUMBER

AREA CODE NUMBER EXT.

15C. CHECK IF REMITTANCE ADDRESS IS

DIFFERENT FROM ABOVE - ENTER SUCH

ADDRESS IN SCHEDULE.

17. SIGNATURE 18. OFFER DATE

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEMS 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL OPEN COMPETITION:

10 U.S.C. 2304 (c) 41 U.S.C. 253 (c)

24. ADMINISTERED BY (If other than Item 7)

26. NAME OF CONTRACTING OFFICER (Type or print)

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

25. PAYMENT WILL BE MADE BY

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

CODE

ITEM

STANDARD FORM 33 (REV,. 9-97)

Prescribed by GSA - Far (48 CFR) 53.214 (c)

SEALED BID (IFB)

NEGOTIATED (RFP)

(Hour) (Date)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

REQ-497-18-000034

USAID/Indonesia, US Embassy Annex, Gedung Sarana Jaya, Jl. Budi Kemuliaan I/1, Jakarta, 10110 Indonesia

72049718R00012

Five (5) OAA, USAID/Indonesia 14:00

Yulian Christanti proposals-indo@usaid.gov

73 157

07/03/2018

6221 34359000

05/22/2018

TABLE OF CONTENTS

COVER LETTER 1

SECTION A – SOLICITATION, OFFER AND AWARD FORM 3

TABLE OF CONTENTS 4

LIST OF ACRONYMS 8

PART I – THE SCHEDULE 10

SECTION B – SUPPLIES OR SERVICES AND COST/PRICES 10

B.1 PURPOSE 10

B.2 CONTRACT TYPE AND CONTRACT SERVICES 10

B.3 ESTIMATED COST, FIXED FEE, AND OBLIGATED AMOUNT 10

B.4 PRICE SCHEDULE 10

B.5 REIMBURSABLE COSTS 11

B.6 INDIRECT COST 11

B.7 ADVANCE UNDERSTANDING ON CEILING INDIRECT COST RATES AND FINAL

PERFORMANCE FOR INDIRECT COSTS 11

B.8 FIXED FEE - FAR 52.216-8 (JUN 2011) 12

B.9 MULTI-YEAR CONTRACT 12

SECTION C – DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK 14

C.1 PURPOSE 14

C.2 BACKGROUND 14

C.3 CONTEXT FOR USAID TBPS ACTIVITIES IN INDONESIA 15

C.4 CURRENT USAID STRATEGIC FRAMEWORK 19

C.5 PAST AND CURRENT USAID ACTIVITIES RELATED TO USAID TBPS 19

C.6 THE VISION FOR USAID’S ROLE IN TB PRIVATE SECTOR CARE IN INDONESIA 26

C.7 TECHNICAL APPROACH 26

C.8 MONITORING AND EVALUATION DATA 41

C.9 USAID TBPS Capabilities 42

C.10 GENDER ANALYSIS 43

C.11 USAID MANAGEMENT 46

C.12 INITIAL ENVIRONMENTAL EXAMINATION (IEE) 47

C.13 LINKS TO REFERENCE DOCUMENTS 47

SECTION D – MARKING AND BRANDING 49

D.1 AIDAR 752.7009 MARKING (JAN 1993) 49

D.2 MARKING AND BRANDING STRATEGY 49

SECTION E – INSPECTION AND ACCEPTANCE 51

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE 51

E.2 INSPECTION AND ACCEPTANCE 51

E.3 PERFORMANCE STANDARDS 51

SECTION F – DELIVERIES OR PERFORMANCE 52

F.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE 52

F.2 PERIOD OF PERFORMANCE 52

F.3 PLACE OF PERFORMANCE 52

F.4 KEY PERSONNEL 52

F.5 REPORTS AND DELIVERABLES 53

SECTION G – CONTRACT ADMINISTRATION DATA 69

G.1 ADMINISTRATIVE CONTRACTING OFFICE 69

G.2 CONTRACTING OFFICER’S AUTHORITY 69

G.3 CONTRACTING OFFICER’S REPRESENTATIVE (COR) 69

G.4 CONTRACTOR’S PRIMARY POINT OF CONTACT 70

G.5 AIDAR 752.7003 DOCUMENTATION FOR PAYMENT (NOV 1998) 70

G.6 PAYING OFFICE 72

G.7 ACCOUNTING AND APPROPRIATION DATA 72

SECTION H – SPECIAL CONTRACT REQUIREMENTS 73

H.1 NOTICE LISTING CONTRACT CLAUSE INCORPORATED BY REFERENCE 73

H.2 AUTHORIZED GEOGRAPHIC CODE 73

H.3 LOGISTIC SUPPORT 73

H.4 LANGUAGE REQUIREMENTS 73

H.5 AIDAR 752.7007 PERSONNEL COMPENSATION (JULY 2007) 73

H.6 AUTHORIZED WORK WEEK 74

H.7 AIDAR 752.7004 EMERGENCY LOCATOR INFORMATION (JULY 1997) 74

H.8 GOVERNMENT FURNISHED FACILITIES OR PROPERTY 75

H.9 AIDAR 752.231-71 SALARY SUPPLEMENTS FOR HOST GOVERNMENT (HG) EMPLOYEES

(MAR 2015) 75

H.10 EXECUTIVE ORDER ON TERRORISM FINANCING (FEB 2002) 75

H.11 AIDAR 752.222-70 USAID DISABILITY POLICY – ACQUISITION (DECEMBER 2004) 75

H.12 AIDAR 752.245-71 TITLE TO AND CARE OR PROPERTY (APRIL 1984) 76

H.13 AIDAR 752.7032 - INTERNATIONAL TRAVEL APPROVAL AND NOTIFICATION

REQUIREMENTS (APRIL 2014) 77

H.14 AIDAR 752.229-71 REPORTING OF FOREIGN TAXES (JULY 2007) 77

H.15 AIDAR 752.222-71 NONDISCRIMINATION (JUNE 2012) 78

H.16 FOREIGN GOVERNMENT DELEGATION TO INTERNATIONAL CONFERENCES (JAN 2002)

H.17 SUBCONTRACTOR CONSENT 79

H.18 BUSINESS CLASS TRAVEL 79

H.19 AIDAR 752.7036 USAID IMPLEMENTING PARTNER NOTICES (IPN) PORTAL FOR

ACQUISITION (JULY 2014) 79

H.20 AIDAR 752.228-3 WORKER’S COMPENSATION INSURANCE (DEFENSE BASE ACT) 81

H.21 DEFENCE BASE ACT (DBA) INSURANCE FOR 2015 – 2020 82

H.22 ELECTRONIC PAYMENTS SYSTEM 84

H.23 VALUE ADDED TAX AND CUSTOMS DUTIES 85

H.24 SUBCONTRACTING PLAN REPORT FOR INDIVIDUAL CONTRACTS AND SUMMARY

CONTRACTING REPORT 85

H.25 CONFLICT OF INTEREST 86

H.26 DISCLOSURE OF INFORMATION 87

H.27 ENVIRONMENTAL COMPLIANCE 88

H.28 PUBLICATIONS, VIDEOS OR OTHER INFORMATION MEDIA PRODUCTS 90

H.29 USAID-FINANCED THIRD-PARTY WEB SITES (AUG 2013) 92

H.30 RESTRICTIONS AGAINST DISCLOSURE (MAY 2016) 93

H.31 SOFTWARE LICENSE ADDENDUM (MAY 2016) 94

H.32 ELECTRONIC AND INFORMATION TECHNOLOGY (MAY 2016) 94

H.33 USE OF INFORMATION TECHNOLOGY (MAY 2016) – (DEVIATION NO.M/OAA-DEV-FAR-

16-1c) 95

H.34 MEDIA AND INFORMATION HANDLING AND PROTECTION (MAY 2016) 97

H.35 PRIVACY AND SECURITY INFORMATION TECHNOLOGY SYSTEM INCIDENT REPORTING

(MAY 2016) 99

H.36 SKILLS AND CERTIFICATION REQUIREMENTS FOR PRIVACY AND SECURITY STAFF

(MAY 2016) 103

H.37 SECURITY REQUIREMENTS FOR UNCLASSIFIED INFORMATION TECHNOLOGY

RESOURCES (MAY 2016) 104

PART II – CONTRACT CLAUSES 110

SECTION I – CONTRACT CLAUSES 110

I.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE 110

I.2 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) 114

PART III – LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS 115

SECTION J – ATTACHMENTS 115

PART IV – REPRESENTATION AND INSTRUCTIONS 116

SECTION K – REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF BIDDERS 116

SECTION L – INSTRUCTIONS, CONDITIONS, AND NOTICES TO BIDDERS 128

L.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE 128

L.2 FAR 52.215-1 INSTRUCTIONS TO OFFEROR – COMPETITIVE ACQUISITION (JAN 2004) 128

L.3 52.215-22 LIMITATIONS ON PASS-THROUGH CHARGES – IDENTIFICATION OF

SUBCONTRACT EFFORT (OCT 2009) 133

L.4 52.233-2 SERVICE OF PROTEST (SEP 2006) 134

L.5 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998) 135

L.6 52.216-1 TYPE OF CONTRACT (APR 1984) 135

L.7 QUESTIONS AND CLARIFICATION 135

L.8 PROPOSAL PREPARATION AND DELIVERY INSTRUCTIONS 136

L.10 UNNECESSARILY ELABORATE PROPOSAL 139

L.11 INSTRUCTIONS FOR THE PREPARATION OF THE TECHNICAL PROPOSAL 139

L.12 COMPONENTS OF TECHNICAL PROPOSAL 140

L.13 INSTRUCTIONS FOR THE PREPARATION OF THE COST PROPOSAL 146

L.14 INSTRUCTION FOR THE PREPARATION OF SMALL BUSINESS SUBCONTRACTING

PLAN 156

L.15 INSTRUCTIONS FOR THE PREPARATION OF BRANDING IMPLEMENTATION AND

MARKING PLAN 156

SECTION M – EVALUATION FACTORS FOR AWARD 158

M.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE 158

M.2 GENERAL INFORMATION 158

M.3 TECHNICAL EVALUATION FACTORS 159

M.4 COST EVALUATION FACTOR 161

M.5 DETERMINATION OF THE COMPETITIVE RANGE AND CONTRACT AWARD 162

M.6 CONTRACTING WITH SMALL BUSINESS CONCERN AND DISADVANTAGED

ENTREPRISES 163

M.7 BRANDING IMPLEMENTATION AND MARKING PLAN 163

ATTACHMENT 1 – SF LLL – DISCLOSURE OF LOBBYING ACTIVITIES 164

ATTACHMENT 2 – CONTRACTOR’S PAST PERFORMANCE INFORMATION 168

ATTACHMENT 3 – PAST PERFORMANCE REFERENCE FORM 170

ATTACHMENT 4 – REFERENCES 177

ATTACHMENT 5 – INITIAL ENVIRONMENTAL EXAMINATION (IEE) 192

LIST OF ACRONYMS

AMEP - Activity Monitoring and Evaluation Plan ARSSI - Asosiasi Rumah Sakit Swasta Indonesia ASEAN - Association of Southeast Asian Nations ASKLIN - Asosiasi Klinik Indonesia BAPPENAS - Badan Perencanaan Pembangunan Nasional BCG - Boston Consulting Group BPJS-K - Badan Penyelenggara Jaminan Sosial – Kesehatan BPOM - Badan Pengawas Obat dan Makanan CDCS - Country Development Cooperation Strategy CME - Continuing Medical Education CO - Contracting Officer COR - Contracting Officer’s Representative CTB - Challenge TB CXR - Chest X-Ray DAK - Dana Alokasi Khusus DDL - Development Data Library DEC - Development Experience Clearinghouse DHO - District Health Office DJSN - Dewan Jaminan Sosial Nasional DKI Jakarta - Daerah Khusus Ibukota Jakarta DO - Development Objective DOC - Development Outreach and Communications EMMP - Environmental Mitigation and Monitoring Plan EQA - External Quality Assurance FOIA - Freedom of Information Act GIS - Geographic Information System GFATM - Global Fund to Fight Aids, Tuberculosis and Malaria GMP - Good Manufacturing Practices GOI - Government of Indonesia GP - General Practitioner HF - Health Financing HRH - Human Resources for Health ICT - Information, Communication and Technology IAI - Ikatan Apoteker Indonesia IDI - Ikatan Dokter Indonesia IDAI - Ikatan Dokter Anak Indonesia ISTC - International Standards of TB Care IEE - Initial Environmental Examination ILKI - Ikatan Laboratorium Kesehatan Indonesia IR - Intermediate Results

JEMM - Joint External Monitoring Mission JKM - Jaringan Kesehatan/Kesejahteraan Masyarakat JKN - Jaminan Kesehatan National LKNU - Lembaga Kesehatan Nahdatul Ulama M&E - Monitoring and Evaluation MDR - Multidrug-resistant MoH - Ministry of Health NSP - National Strategic Plan NTP - National Tuberculosis Program PAPDI - Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia PDPI - Perhimpunan Dokter Paru Indonesia PERSI - Perhimpunan Rumah Sakit Seluruh Indonesia PHC - Primary Health Care PHO - Provincial Health Office PIRS - Performance Indicator Reference Sheets PMP - Performance Management Plan PNPK - Pedoman Nasional Pelayanan Kedokteran Tuberkulosis PPJK - Pusat Pembiayaan dan Jaminan Kesehatan PPM - Public Private Mix PPR - Performance Plan and Report PSM - Procurement and Supply Management PQM - Promoting the Quality of Medicines RCD - Roman Catholic Diocese of Timika RPJMN - Rencana Pembangunan Jangka Menengah Nasional TBPS - Tuberculosis Private Sector TNP2K - Tim Nasional Percepatan Penanggulangan Kemiskinan

PART I – THE SCHEDULE

SECTION B – SUPPLIES OR SERVICES AND COST/PRICES

B.1 PURPOSE

The purpose of this Contract is to provide technical assistance and other services as described in detail in Section C, Statement of Work, to contribute to national goals to reduce tuberculosis (TB) incidence and mortality by increasing the number of private provider clients who receive quality TB services.

B.2 CONTRACT TYPE AND CONTRACT SERVICES

This is a Cost-Plus-Fixed-Fee (CPFF) completion type contract. For the consideration set forth below, the Contractor must accomplish the performance objectives and provide the results, deliverables and output as described in Section C and Section F, and in accordance with the performance standards specified therein.

B.3 ESTIMATED COST, FIXED FEE, AND OBLIGATED AMOUNT

B.3.1 The estimated cost for the performance of the work required hereunder, exclusive of fixed fee, if any, is $ [INSERTED AT AWARD]. The fixed fee, if any, is $ [INSERTED AT AWARD]. The total estimated cost plus fixed fee, if any, is $ [INSERTED AT AWARD].

B.3.2 Within the estimated cost plus fixed fee (if any) specified in paragraph B.3.1.(a) above, the amount currently obligated and available for reimbursement of allowable costs incurred by the Contractor (and payment of fee, if any) for performance hereunder is $ [INSERTED AT AWARD]. The Contractor must not exceed the aforesaid obligated amount nor will the Government be responsible for costs incurred should the Contractor do so.

B.3.3 Funds obligated hereunder are anticipated to be sufficient through [INSERTED AT

AWARD].

B.4 PRICE SCHEDULE

The Contractor is not allowed to exceed any Contract Line Item nor is authorized to shift funding between Contract Line Items without prior written approval of the Contracting Officer.

The fee is fixed according to the Contract Summary Budget and the terms of this Contract.

[ PRICE SCHEDULE INSERTED AT AWARD]

B.5 REIMBURSABLE COSTS

The U.S. dollar costs reimbursable under this contract will be limited to those costs determined to be necessary allocable, allowable, and reasonable as determined in accordance with FAR 31 (Contract Cost Principles), 2 CFR 215 (Uniform Administrative Requirements for Grants and Agreements with Institutions of Higher Education, Hospitals, and Other Non-profit Organizations), 2 CFR 230 (Cost Principles for Non-Profit Organization), FAR 52.216-7, (Allowable Cost and Payment), and FAR 52.216-8, (Fixed Fee), if applicable, and AIDAR 752.7003 (Documentation for Payment).

B.6 INDIRECT COST

The Contractor is allowed to recover applicable indirect costs (i.e., overhead, G&A, etc.) on other direct costs (ODCs), if it is part of the Contractor’s usual accounting procedures, consistent with FAR Part 31, and an approved Negotiated Indirect Cost Rate Agreement

(NICRA).

Pending establishment of revised provisional or final indirect cost rates, for each of the Contractor’s accounting periods which apply to this Contract, allowable indirect costs must be reimbursed on the basis of the following negotiated provisional or predetermined rates applied to the bases which are set forth below:

Description Year 1 Year 2 Year 3 Year 4 Year 5

Type of Rate:

Base of Application:

Period:

[INDIRECT COST FOR PRIME CONTRACTOR AND

ANY MAJOR SUBCONTRACTORS INSERTED AT AWARD]

B.7 ADVANCE UNDERSTANDING ON CEILING INDIRECT COST RATES AND FINAL

PERFORMANCE FOR INDIRECT COSTS

B.7.1 Reimbursement for indirect costs will be at final negotiated rates, but not in excess of the following ceiling rates:

Description Year 1 Year 2 Year 3 Year 4 Year 5 Type of Rate:

Base of Application:

Period:

[CEILING RATES FOR PRIME CONTRACTOR AND

ANY MAJOR SUBCONTRACTORS INSERTED AT AWARD]

B.7.2 The U.S. Government will not be obligated to pay any additional amount should the final indirect cost rates exceed the negotiated ceiling rates. If the final indirect cost rates are less than the negotiated ceiling rates, the negotiated rates will be reduced to conform with the lower rates.

B.7.3 This understanding must not change any monetary ceiling, obligation, or specific cost allowance or disallowance. Any changes in classifying or allocating indirect costs require the prior written approval of the Contracting Officer.

B.8 FIXED FEE - FAR 52.216-8 (JUN 2011)

USAID paying office ordinarily pays the Contractor a percentage of a fixed fee that directly corresponds to the percentage of allowable costs being paid. Two exceptions to paying fixed fee in this manner apply:

(1) If the CO determines that this method results in paying a disproportionately higher ratio of fixed fee than the percentage of work that the Contractor has completed, then the CO may suspend further payment of any fixed fee until the Contractor has made sufficient progress to justify further payment, up to the agreed percentage.

(2) The clauses entitled "Allowable Cost and Payment" (FAR 52.216-7) and "Fixed Fee" (FAR 52.216-8) are incorporated into this contract. The terms and conditions of these clauses apply after total payments of fixed fee reach eighty-five percent (85%) of the total fixed fee.

B.9 MULTI-YEAR CONTRACT

All contract CLINs under this award are considered non-severable and constitutes a multi-year contract as defined in FAR 17.103. Therefore, this contract is subject to the requirements of FAR 17.106. In the event that the Government cancels requirements for services in subsequent program years under this contract, the following conditions will apply:

[CANCELLATION DATES AND AMOUNTS INSERTED AT AWARD]

Cancellation Dates:

Contract Year 2: DATE TBD, 2019 Amount: $1 Contract Year 3: DATE TBD, 2020 Amount: $1 Contract Year 4: DATE TBD, 2021 Amount: $1 Contract Year 5: DATE TBD, 2022 Amount: $1

Cancellation Ceiling:

This is a CPFF completion type contract where the Contractor is authorized to be reimbursed for all costs which are allowable in accordance with FAR 52.216-7, “Allowable Costs and Payment (June 2013).” Therefore, the Contractor will not incur any costs which would have been amortized over the life of the contract should the contract be cancelled in accordance with FAR 52.217-2, “Cancellation under Multi year Contracts (October 1997).” Therefore, the cancellation ceiling for each cancellation date is provided above.

[END OF SECTION B]

SECTION C – DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1 PURPOSE

The purpose of the USAID Tuberculosis Private Sector Activity (hereafter referred to as “USAID TBPS” or the “Activity”) is to contribute to national goals to reduce tuberculosis (TB) incidence and mortality by increasing the number of private provider clients who are correctly diagnosed, notified and receive quality TB services.

C.2 BACKGROUND

C.2.1 Indonesia has the Second Largest TB Burden in the World1

TB is the greatest killer worldwide due to a single infectious agent. Indonesia has the second largest TB burden in the world, with an estimated 1.6 million prevalent cases and 1 million incident cases per year (including an estimated 32,000 multidrug-resistant TB (MDR-TB) cases per year). In 2016, 358,608 new and relapse TB patients were notified in Indonesia, and the most recent cohort of notified patients had a treatment success rate of 85%. However, this means that only 35% of the estimated total of TB patients in the country are identified and notified. An inventory study2 that is currently underway in Indonesia will provide additional information on treatment location and gaps in notification.

C.2.2 TB Patient Volumes in the Private Sector are High and Practices Not Optimal

Volume: The 2013-14 Indonesia TB prevalence survey indicated that 60% of clients with TB symptoms sought their initial care in the private sector; a recent patient pathway analysis used this and other data sources to estimate an even higher figure of 74% initial care seeking in the private sector.3 In terms of their eventual treatment location, the prevalence survey found that 42% of TB treatment (vs 9% of TB notifications) ended up taking place in the private sector, consistent with a survey of TB drug sales in 2009 that showed a large volume of TB drugs in the private sector.4

Case Notification: Given the public health mandate of the National Tuberculosis Program (NTP), private providers have not historically been a focus of TB interventions. This is

WHO TB report 2017. http://who.int/tb/publications/global_report/en/

2 http://www.who.int/tb/publications/inventory_studies/en/ 3 Surya et al. Quality Tuberculosis Care in Indonesia: Using Patient Pathway Analysis to Optimize Public-Private Collaboration. J Infect Dis. 2017 Nov 6;216(suppl_7):S724-S732. doi: 10.1093/infdis/jix379.

4 Wells WA, Ge CF, Patel N, Oh T, Gardiner E, Kimerling ME. Size and usage patterns of private TB drug markets in the high burden countries. PLoS One. 2011 May 4;6(5):e18964. doi: 10.1371/journal.pone.0018964.

reflected in the very low rates of case notification from the private sector, with only 9% of TB cases reported to the NTP originating with private providers. There is a steep drop-off from private care-seeking (60-74%) to private TB treatment (42%) to private TB notification (9%), indicating a multitude of lost opportunities to identify and notify TB patients in the private sector.

TB notification is not an end in itself, but forms the basis for monitoring and improving the quality of treatment. A number of studies in Indonesia have investigated care-seeking behaviors of TB symptomatic and resulting private provider actions. Consistent with evidence from international journals, a number of these local studies indicate substantial weaknesses in current private provider practice.5

C.3 CONTEXT FOR USAID TBPS ACTIVITIES IN INDONESIA

The relevant contextual factors for the USAID TBPS Activity in Indonesia includes the three topics outlined below: overall political structure and governance; national approaches to TB private provider engagement; and the health financing landscape. All three topics are critical since the USAID TBPS Activity will be integrated with these national structures and strategies.

C.3.1 Political Structure and Governance

Indonesia is a diverse and highly decentralized middle-income country. There are multiple government actors who impact the issues considered here, including:

● Ministry of Health (MOH) / National TB Program (NTP), who sets standards for the TB response across the country and reports to the Director General of the Center for Disease Control (Direktur Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan, Kementerian Kesehatan, Ditjen PPPL).

● National Health Insurance Agency (Badan Penyelenggara Jaminan Sosial-Kesehatan, BPJS-K), who acts as the single payer health insurance agency under the Government of Indonesia’s (GOI) Universal Health Insurance Program (Jaminan Kesehatan Nasional, JKN).

● MOH / Center for Financing and Risk Protection (Pusat Pembiayaan dan Jaminan Kesehatan, PPJK), who develops policies with regard to health expenditure tracking, private sector engagement and health financing related to the national health insurance program.

5 For example, see: Mahendradhata Y, et al. How do private general practitioners manage tuberculosis cases? A survey in eight cities in Indonesia. BMC Res Notes. 2015 Oct 14;8:564. doi: 10.1186/s13104-015-1560-7, and related articles from this and other research groups in Indonesia.

● National Development Planning Body (BAPPENAS), who is in charge of developing the National Mid Term Development Plan (RPJMN) by connecting different ministries to achieve common development goals.

● Provincial Health Offices, located in each Province, are responsible for budgeting, planning and implementing health services delivery at the provincial level, as well as providing oversight and guidance to the District Health Offices.

● District Health Office, located in the District, is responsible for budgeting, planning and implementing health services delivery at the district level.

● Professional Associations are responsible for engaging and setting norms for their membership. Some of the key institutions include associations for pulmonologists (Perhimpunan Dokter Paru Indonesia - PDPI), medical doctors (Ikatan Dokter Indonesia - IDI), internists (Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia - PAPDI), pediatricians (Ikatan Dokter Anak Indonesia - IDAI), pharmacists (Ikatan Apoteker Indonesia - IAI), laboratory technicians (Ikatan Laboratorium Kesehatan Indonesia - ILKI), hospitals (Perhimpunan Rumah Sakit Seluruh Indonesia - PERSI), medical clinics (Asosiasi Klinik Indonesia - ASKLIN) and private hospitals (Asosiasi Rumah Sakit Swasta Indonesia - ARSSI).

C.3.2 National Approaches to Engaging Private Providers in TB

Engaging with private providers for TB care is essential so that resources can be directed where they are most needed, and so that quality of care can be improved to prevent the development of MDR-TB. The international effort on this front has been termed public-private mix (PPM). The outcomes of private provider engagement for TB in Indonesia were reviewed in depth during the Joint External Monitoring Mission (JEMM)6 in January 2017.

The importance of engaging private providers in Indonesia has been recognized in national TB plans since at least 2006. For the 2015-2019 National Strategic Plan (NSP), “improvement of networking TB services through public-private mix” is one of the main activities under Strategy 2: improving the quality of “TOSS-TB” (Temukan Obati Tuberkulosis Sampai Sembuh - Find and Treat TB until Recovered) services. Planned activities include developing technical guidance for district-based PPM, mapping service providers, signing MOUs and working with professional societies. Indicator 2.1 is “% of districts/municipalities with at least 80% of health services involved in PPM”, which is supposed to increase from 10% in 2016 to 90% in 2020, but this indicator focuses on coverage not programmatic achievement. The NSP includes estimates of funding requirements for each of the six major NSP strategies, but there is no indication of any budget specifically for engaging private providers.

6 MoH. (2017) The Joint External TB Monitoring Mission (JEMM TB) Indonesia http://www.searo.who.int/indonesia/topics/tb/tuberculosis_jemm_2017_for_ino_website.pdf?ua=1

The NSP 2015-2019 estimates that only 2% of the private sector service providers are presently engaging with the NTP and only a very limited number of private providers are following national clinical standards and guidelines for TB care. Efforts to engage private providers have focused to-date on specialists and hospitals, where the numbers of patients per provider or facility tend to be higher than at the primary care level. The Pulmonologist Society, PDPI, has been working with the NTP since 2010 to improve involvement of pulmonologists and to increase adherence to treatment standards [the International Standards of TB Care (ISTC), or its Indonesian equivalent the Pedoman Nasional Pelayanan Kedokteran Tuberkulosis (PNPK)], in partnership with the American Thoracic Society and with funding from USAID and the Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM). This has been a high yield intervention, but thus far has typically stopped with the specialists, rather than using the specialists to reach large numbers of GPs. In addition, efforts with both specialists and hospitals were reliant on donor funding, and ceased when donor support finished.

By contrast, there have been very few efforts to engage private providers at the primary care level. A $1 million TB REACH/Unitaid project, implemented by REMDEC in DKI Jakarta from 2013 to 2016, intended to engage private GPs and introduce GeneXpert, but could not be implemented as planned and had challenges with high pretreatment loss to follow-up. As well since 2014, there has been an initiative to certify GPs for TB care. This remains a potentially viable approach if improved, but historically the lengthy trainings, complex approval process, and multiple other ways to earn continuing medical education (CME) points resulted in only 35 GPs being certified.

In addition to the quality of care challenges, TB notification rates are abysmally low. Despite a decree by the Minister of Health stating that TB is a notifiable disease and that all health providers delivering TB services are obliged to report cases to the NTP, few if any private providers comply. To be effective, such a decree requires a simplified system for notification;

WIFI-TB (see below) is an attempt to introduce such a system.

Based in part on the lessons learned from USAID-funded PPM programming (see Section C.5.1), the NTP has recently developed and embraced the district PPM model. In this model, a district-based team including health and governance authorities, medical associations, and other relevant institutions oversees overall PPM programming. Importantly, under this model, outreach to and engagement of individual practitioners and group clinics is devolved to the sub-district level, using puskesmas (primary health care center) staff, whereas outreach to hospitals is the direct responsibility of district-based staff. Under this approach, the NTP makes program drugs available to private providers. This model is currently being rolled out with the assistance of Challenge TB (see below), and will form the foundation for private provider approaches to be implemented under the USAID TBPS Activity.

C.3.3 JKN and the Role of BPJS-K for TB

The recent expansion of national health insurance in Indonesia brings increased opportunities to influence provider behaviors via financial levers. JKN currently provides health insurance coverage to over 180 million people, or almost 70% of the population, of whom over 92 million have subsidized premium payments from the government. The government aims to cover all its expected 275 million citizens by 2019.

Currently, only approximately 17 percent of the country’s total health expenditure, and approximately 30 percent of government spending on health, flows through the JKN system.

However, as more people are enrolled and start to utilize care under the JKN program, expenditures through JKN are expected to increase. Already, more than 780 public hospitals, 1190 private hospitals, and 9180 clinics are contracted by BPJS-K.7 Indonesia’s single-payer system has unleashed the power of strategic purchasing and has significant potential to dramatically increase efficiencies in resource allocation and to increase access and financial protection for the poorest and most vulnerable.

However, under the current provider payment system (capitation at primary care and Indonesia-Case Based Groups at secondary care), JKN does not encourage optimal TB case finding or efficient case management at the primary or secondary care level.8 Currently, primary care capitation payments do not include TB-related performance incentives or specific payments for required diagnostics and pharmaceuticals, outside of what is included in the capitation payment. As a result, it seems that covering TB through the current capitation payment system is creating an incentive for primary health care (PHC) providers to refer TB cases to secondary and tertiary hospitals, and to avoid case-finding. For those who do treat clients at the primary care level, there is very little incentive to actively follow them through treatment completion. The lack of clarity over optimal patient pathways, and the absence of incentives that align with those optimal pathways, results in patient and provider confusion, increased out-of-pocket costs, and excessive use of secondary care for TB symptomatics and patients. In addition, opportunities to screen outpatient clients for TB symptoms are also lost, because this is not a compensated activity under BPJS-K.

There are ongoing efforts to further understand and pursue these issues by the GOI and other donors such as the World Bank and GFATM. Many of these efforts, whether they include TB explicitly or not, will provide data inputs for more evidence-based planning for TB interventions. For example, amongst other financing activities by GOI, the MOH-PPJK is producing unit cost data for JKN and non-JKN hospitals to get better cost of care data to inform INA-CBG provider tariff adjustments. In addition, BPJS-K is modifying capitation at PHC (based on, for example, contact rate, prevention activities, human resources for health, 7 See https://faskes.bpjs-kesehatan.go.id/aplicares/#/app/peta for numbers and distribution of BPJS-K providers.

8 See links to the JEMM and BCG reports in Section C.11.

etc.). The World Bank activities include a Quantitative Service Delivery Survey with a sub-module for TB services in both public and private sectors; a Public Expenditure Tracking Survey that includes information on TB program specific financing and a recently completed Health Financing Sector Assessment (published in 2016).9

C.4 CURRENT USAID STRATEGIC FRAMEWORK

This Activity is aligned with USAID/Indonesia’s Country Development Cooperation Strategy (CDCS). The current CDCS seeks to reorient USAID’s strategic engagement in Indonesia and provides an opportunity to address self-reliance, in this case in the area of national resource mobilization for TB. USAID/Indonesia’s CDCS 2014–2019 has three integrated Development Objectives (DOs):

● DO 1: Democratic governance and security strengthened;

● DO 2: Essential human services to targeted populations improved and sustained; and

● DO 3: Development priorities for mutual prosperity advanced.

The Activity falls under the Infectious Disease Project, which implements intermediate result (IR) 3.1 Infectious disease threats reduced, under DO3.

USAID’s partnership with the GOI in infectious diseases reflects Indonesia’s commitment to improving and protecting the health of Indonesians, the region and the world. The Activity intends to build on Indonesia’s significant achievements in health and the country’s aspiration to be self-reliant and a leader in the region. It also focuses on engaging and expanding Indonesia’s commitment and adherence to international standards of care and disease control, and strengthening its capacity for prevention, surveillance, and treatment of infectious diseases.

C.5 PAST AND CURRENT USAID ACTIVITIES RELATED TO USAID TBPS

A number of past and current USAID activities are related to USAID TBPS, and provide a foundation for the Activity’s efforts. These include USAID support focused on general TB technical assistance, TB private care analysis, specialized topics in TB, and social health insurance in general, as outlined below.

World Bank, 2016. Indonesia Health Financing System Assessment.

http://documents.worldbank.org/curated/en/453091479269158106/pdf/110298-REVISED-PUBLIC-HFSA-Nov17-LowRes.pdf

C.5.1 General TB Technical Assistance

Historically, USAID efforts in engaging the private sector to improve TB case notification and treatment success rates in Indonesia have been limited. However, recently, USAID has invested some resources in addressing private sector engagement in a scalable and sustainable manner, i.e., by integrating evidence-based approaches into the underlying health system.

TB CARE (2008-2013) implemented the following private sector activities in Indonesia: 1) initiated a Hospital DOTS Linkage Model, which struggled to maintain quality or to reach scale and was based on retaining patients under hospital care; 2) engaged specialists via the pulmonologists’ professional association (PDPI); 3) utilized one to three Wasors (GOI TB supervisors) at the district level in an attempt to engage large numbers of providers (up to 500+ individual private providers and up to 100 hospitals); 4) established PPM teams at the district level for coordination purposes, but with no concrete scale-up potential or clear incentives for sustained implementation; and 5) produced a financing transition strategy to guide the expected transition from GFATM to domestic financing.

Challenge TB (2014-2019, CTB), the current flagship USAID/Indonesia TB project, operates in 16 districts and is implementing the following activities to improve private sector engagement:

1) assisting in the identification of minimum notification/reporting requirements for private sector notification and collaboration with the NTP; 2) using this minimum reporting requirement to develop a simplified, electronic reporting system (WiFi-TB) and method for all providers (including private providers) to notify cases, with an eventual link to the future, general electronic TB reporting system (SITB); 3) developing, with NTP, the model of using the sub-district level (puskesmas TB focal point) to engage GPs, whereas the district level would focus on hospital engagement, thus making the numbers more manageable; 4) developing some initial quality assurance tools for TB, including hospital accreditation tools and GP certification tools, although uptake and implementation remains limited; 5) drafting JKN quality standards guideline for TB, though this guideline still has many areas for further improvement and has not been widely implemented; 6) providing technical assistance on distance learning programs for private practitioners, though with limited penetration and with some modules remaining overly long. Challenge TB also helped NTP to establish a district planning approach for TB in general, which helped with prioritization of TB, domestic resource mobilization, and activity planning, and there are clear lessons from this work on how to engage and advocate with district stakeholders on TB.

The aim of the TB CARE I and Challenge TB private sector related activities has been to increase the percentage of notified TB cases from the private sector, increase the number of private providers certified to provide TB services, and increase the number and percent of TB cases successfully treated in the private sector. Progress on these indicators was sometimes slow, but CTB districts now have an average of 24% notification from the private sector, compared to 9% nationally. Given that Challenge TB adopted an approach that is aligned with the decentralized, district-focused governance of the country’s health system, there is a likely pathway to impact. In 2016, Challenge TB focused on 16 districts and started facilitating a process of district planning for TB. In addition, one year ago, the project began emphasizing sub-district-based engagement with private primary care providers.

The NTP combined the PPM team concept from TB CARE I with the sub-district engagement approach from Challenge TB to develop the district PPM approach. This approach has strong support from the MoH. Any future interventions must take this historical context into full consideration and build on the MOH’s district PPM concept. The current status of district PPM implementation by Challenge TB and NTP is outlined in the Annex A of attachment 4 .

This Activity will serve as USAID’s main investment in supporting Indonesia to improve TB services in the private sector. As Challenge TB concludes in September 2019, all private sector related activities, currently under the Challenge TB project, will be transitioned over to the USAID TBPS Activity. In addition to building on the district-based PPM approach and other lessons from TB CARE I and Challenge TB, USAID TBPS will also utilize market-based approaches such as those outlined in the BCG private sector report (see next section and the link to the full report in Section C.11).

C.5.2 TB Private Provider Analysis

In 2017, USAID/Indonesia commissioned the Boston Consulting Group (BCG) under the Scale for Impact project to undertake a human-centered design analysis of patient and provider experiences in TB private sector care.10 This was conducted in four districts - Medan (North Sumatra province), North Jakarta and East Jakarta (DKI Jakarta province), and Jember (East Java province). High level findings included that: the current provider payment system implemented through BPJS-K was a significant driver of both patient and provider behavior;

current national, provincial and district TB programming had limited reach to private providers;

and there are significant incentives for patients to prioritize private and secondary care over public and primary care. Finally, there were identified opportunities to improve the quality of private sector TB care to: counter delayed care seeking (especially of clients self-referring to pharmacies); reduce access barriers to diagnostics; overcome the lack of mechanisms and incentives for providers to notify TB patients; and provide treatment adherence support mechanisms for patients.

Four key factors were found to be driving the shift in care-seeking behavior from primary care to secondary care and from public to private providers:

Further details can be found in the BCG report (see link in Section C.11).

1. Low patient awareness of TB symptoms leads to delayed care-seeking and therefore delays treatment, resulting in more severe cases of TB and a potential increase in care-seeking to hospitals;

2. Patient preferences, e.g., convenience of "one-stop shop" services that include clinical and lab diagnosis plus pharmacy, shorter wait times, and perceived higher service quality and cleanliness.

3. Patient economics, e.g., additional costs covered via BPJS-K at in-house hospital labs and pharmacies.

4. Provider willingness and economics, e.g., GPs do not feel confident about diagnosing TB, and perceive the capitation funds that are inclusive of consultation and diagnostics are not sufficient to cover TB care.

Based on the four factors above, stakeholder inputs yielded a number of observations and themes. First, regulation is not a sufficient lever to drive behavior change in the private sector, but incentives show greater potential to change private sector provider behaviors. Payments through BPJS-K were seen as more influential than potential payments through other input based financing sources coming from the MOH through national priority program funding or from provincial and district governments. Such solutions are needed for the entire TB cascade, including diagnostics, with access to GeneXpert in the private sector being a particular priority. Second, any solutions for the private sector should meet private sector needs by being targeted, simple, and consistent, such as short trainings and tools that emphasize practical steps over theory. Third, patients play an important role in their own care, so information for patients is also critical to influencing provider decisions positively. Finally, an increased focus is needed on the development of an integrated solution for primary care, both to improve quality and to retain patients in care.

In addition to the BCG study, a set of private provider TB studies planned over the coming two years under a USAID-funded Partnerships for Enhanced Engagement in Research (PEER) grant will provide:11

● A quantitative measure of health seeking pathways and delays (via patient interviews);

● A quantitative measure of diagnostic and treatment behaviors of private providers, as measured by the use of mystery patients; and

● A qualitative (or mixed methods) analysis of provider behaviors and the reasons behind them, as assessed via direct interviews. This will use findings from the first two studies as a basis for questioning the providers.

See study description at: http://sites.nationalacademies.org/PGA/PEER/PEERscience/PGA_174222 . These studies are already fully staffed and funded, but USAID TBPS would be expected to engage with the implementers to maximize cross-learning.

C.5.3 Specialized Topics in TB

In addition to the broad-based TB technical assistance and the specific private sector support described above, USAID/Indonesia has provided TB-related support in the areas of community engagement, supply chain management, and drug quality. Details are below.

USAID/Indonesia launched the Community Empowerment of People Against Tuberculosis (CEPAT) (2012-2017/2018) in partnership with the NTP. The principal objective of CEPAT was to support the NTP in “achieving universal access to quality and early TB diagnosis and treatment through community empowerment.” To do this, the project used community mobilization and advocacy to support improved TB care. Three cooperative agreements were awarded to three Indonesian non-government organizations: Lembaga Kesehatan Nahdatul Ulama (LKNU), Jaringan Kesehatan/Kesejahteraan Masyarakat and Roman Catholic Diocese of Timika. The program was implemented in North Sumatra, West Sumatra, West Java, DKI Jakarta, East Java, Papua and West Papua provinces. Partnering with these Indonesian NGOs, the program focused on increasing people’s awareness on TB prevention and early detection, as well as fostering local commitment to support the national program. A number of these approaches have been taken up under Global Fund, notably via the efforts of Nahdatul Ulama, the parent organization of LKNU.

For the TB field in general, community linkages remain important for case finding and treatment completion, but the specific model appropriate for Indonesia remains less clear. The use of donor-funded, TB-only cadres is clearly not a sustainable approach. Challenge TB has been encouraging the integration of community-based organizations into district TB planning.

But overall the question remains: what community TB approach is really appropriate in a middle income country with extensive social health insurance and increasing urbanization?

Two other related USAID/Indonesia investments include support from centrally managed global mechanisms to help achieve national goals in TB and HIV. The first is the Global Health Supply Chain Program - Procurement and Supply Management (PSM; 2016 - 2020). This project is tasked with strengthening supply chain management, including strategic planning for supply chain management and commodity security, providing technical assistance related to logistics (e.g.